Racial/Ethnic Differences in Associations of Non-cigarette Tobacco Product Use with Subsequent Initiation of Cigarettes in US Youths

Andrew C. Stokes, Anna E. Wilson, Dielle J. Lundberg, Wubin Xie, Kaitlyn M. Berry, Jessica L. Fetterman, Alyssa F. Harlow, Yvette C. Cozier, Jessica L. Barrington-Trimis, Kymberle L. Sterling, Emelia J. Benjamin, Michael J. Blaha, Naomi M. Hamburg, Aruni Bhatnagar, Rose Marie Robertson

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Understanding which non-cigarette tobacco products precede smoking in youth across different racial/ethnic groups can inform policies that consider tobacco-related health disparities. Methods: We used nationally representative, longitudinal data from the Population Assessment of Tobacco and Health Study waves 1-4. The sample was a dynamic cohort of cigarette-naïve youth aged 12-17 years. Mixed-effects models were used to assess non-cigarette product (e-cigarette, cigar product, or other product) use with cigarette use over 1-year intervals. Results: Of the 28 788 observations pooled across waves 1-4, respondents were 48.7% non-Hispanic white, 13.9% non-Hispanic black, and 23.1% Hispanic. Odds of cigarette initiation over 1-year follow-up were higher among youth with prior use of e-cigarettes (odds ratio [OR], 2.76; 95% confidence interval [CI], 2.21-3.45), cigars (OR, 2.00; 95% CI, 1.42-2.80), or other products (OR, 1.66; 95% CI, 1.28-2.14) compared to never users. At the population level, 20.6% of cigarette initiation was attributable to e-cigarette use among white youth and 21.6% among Hispanic youth, while only 3.5% of cigarette initiation was attributable to e-cigarette use among black youth. In contrast, 9.1% of cigarette initiation for black youth was attributable to cigar use compared to only 3.9% for both white and Hispanic youth. Conclusions: Prior use of e-cigarettes, cigars, and other non-cigarette products were all associated with subsequent cigarette initiation. However, white and Hispanic youth were more likely to initiate cigarettes through e-cigarette use (vs. cigar or other product use), while black youth were more likely to initiate cigarettes through cigar use (vs. e-cigarette or other product use). Implications: Our findings suggest that previous studies on effects of non-cigarette tobacco products may overlook the critical role of cigar products as a pathway into cigarette smoking among US youth, particularly black youth. While our data support the importance of e-cigarette use as a pathway into smoking, regulatory actions aimed at addressing youth e-cigarette use alone may contribute to disparities in black versus white tobacco use and further exacerbate inequities in tobacco-related disease. Thus, contemporary policy development and discourse about the effects of non-cigarette tobacco products on cigarette initiation should consider cigar and other non-cigarette products as well as e-cigarettes.

Original languageEnglish (US)
Pages (from-to)900-908
Number of pages9
JournalNicotine and Tobacco Research
Volume23
Issue number6
DOIs
StatePublished - Jun 1 2021

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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